Insurance-sponsored diabetes prevention program getting results

Instructor Joannie Malek leads a water aerobics class at the Tri-County YMCA in
Menomonee Fallsk, Wisc. on May 20, 2014. The course, for people with prediabetes, is
being promoted by UnitedHealthcare. (Rick Wood/Milwaukee Journal Sentinel/MCT)

Dave Elmer remembers being irked at a health screening when a nurse told him — in a nice way — that he was a mess.

She also forcefully encouraged him to enroll in a program offered at his local YMCA for people at risk of developing diabetes.

“It’s the best thing that’s ever happened to me,” said Elmer, a certified public accountant who lives in Menomonee Falls, Wis.

When he began the 16-week program, Elmer would get winded walking a few blocks. Six months later, he was taking six-mile walks, and he now walks two to six miles a day, five or six times a week.

His weight has fallen to 170 pounds from 217 pounds. His blood pressure and blood sugar are down. And he no longer is at risk for diabetes.

“My numbers are all within the normal range,” Elmer said.

Elmer is among more than 800 people in southeastern Wisconsin, and more than 19,500 nationwide, who have enrolled in the Diabetes Prevention Program offered by YMCA of the USA in partnership with the Centers for Diseases Control and Prevention and UnitedHealth Group.

The program, launched in 2010, is an example of a proven, cost-effective, scalable initiative that focuses on keeping people healthy and, in the process, changes lives and helps slow the rise in health care costs.

It also is an example of an approach to improving health that takes place in the community and not a doctor’s office.

Nationally, if trends continue, an estimated 40 million adults could have diabetes by 2021, up from 28 million in 2011, according to an article in Health Affairs, a policy journal, by UnitedHealth Group doctors and executives. An estimated 100 million people could have prediabetes by then.

YMCA of Metropolitan Milwaukee introduced the Diabetes Prevention Program in 2011. YMCA of Central Waukesha County, in partnership with YMCA at Pabst Farms, and YMCA of Kettle Moraine, did the same last year.

The response, so far, has been strong.

Roughly 300 people enrolled in 39 classes offered last year by the YMCA of Metropolitan Milwaukee, with the cost for 277 of them paid by their employer through UnitedHealthcare. This year, the YMCA hopes to enroll 455 people in 45 classes.

The classes are offered at Y’s as well as workplaces and community sites.

The 16-week course, which is followed by monthly meetings, includes information on diet and exercise. But more than anything else, the program sets out to change lifestyles in a way that is supportive and nonjudgmental.

Vicki Olejnik, who is nearing the end of the program, initially thought that 16 weeks was a long time.

“Now I’m kind of sorry it’s almost over,” she said.

Olejnik, who has tried several diets over the years, has lost 24 pounds since the start of the program.

“It’s surprisingly easy,” she said. “And I still can eat things I enjoy.”

People in the program keep track of what they eat but track fat grams instead of calories.

“I learned that how I was eating was all wrong,” said Olejnik. “And that is why I wasn’t losing weight.”

Olejnik, who is 69 and works for Milwaukee County, was contacted by UnitedHealthcare after a health screening that is part of the county’s wellness program. Olejnik’s mother and grandmother developed diabetes. And she knew her blood sugar was high.

The program is an outgrowth of a study by the CDC and the National Institutes of Health that compared the effectiveness of a diabetes drug with a program to help people lose at least 7% of their weight through diet, exercise and individual counseling.

The results, published in 2002, showed that the weight loss reduced the risk of developing diabetes by 58% over three years, compared with 31% for people who took the drug metformin.

Researchers at Indiana University then modified the program and worked with the YMCA in Indianapolis to adopt the model for small groups.

The CDC provided funding for a pilot program at several YMCA sites. In 2010, UnitedHealth Group proposed taking the program nationwide and offering it as a benefit in its health plans.

Between one-third and two-thirds of the people with prediabetes are likely to develop type 2 diabetes within six years, compared with 5% of those with normal blood sugar. And the potential benefits of preventing the disease are clear.

According to the article in Health Affairs, an analysis of UnitedHealthcare claims data found:

The average total annual cost for an adult with employer coverage who was diagnosed with diabetes was $11,700 in 2009, compared with $4,400 for an adult who did not have the disease.

The average annual cost for an adult with diabetes who developed complications was $20,700.

Annual health care spending attributable to prediabetes or diabetes could rise from $206 billion in 2011 to $512 billion by 2021. Almost two-thirds of the cost would be incurred by Medicare and Medicaid because of the higher prevalence of the disease among people covered by the programs.

As of March 31, the program has held 2,477 classes in 41 states, and Y associations have trained 1,883 lifestyle coaches.

“Each year it continues to grow,” said Ellie Duyser, a registered dietitian and director of the Diabetes Prevention Program for the YMCA of Metropolitan Milwaukee.

Part educational, part support group, the program sets realistic goals. “This is about life-sustaining changes,” Duyser said.